An Imported Case of Brucella melitensis Infection in South Korea / 감염과화학요법

Brucellosis is a zoonotic infection that is usually transmitted from cattle to humans through ingestion of animal milk, direct contact with animal parts, or inhalation of aerosolized particles. In Korea, brucellosis seem to be transmitted through close contact with blood, fetus, urine, and placenta of domestic cow that has been infected by Brucella abortus, or inhalation of B. arbortus while examining or slaughtering cow. Brucella melitensis infection is rare in Korea and there have been no reported cases of B. melitensis originating from other countries until now. This report details a case of complicated brucellosis with infective spondylitis in a 48-year-old male construction worker recently returned from Iraq. Infection with B. melitensis was confirmed using 16s rRNA sequencing and omp31 gene analysis. The patient was successfully treated using a combination of rifampin, doxycycline, and streptomycin, in accordance with WHO guidelines. This is the first reported case of complicated brucellosis with infective spondylitis in Korea caused by B. melitensis originating from Iraq.

An Imported Case of Brucella melitensis Infection in South Korea / 감염과화학요법

Brucellosis is a zoonotic infection that is usually transmitted from cattle to humans through ingestion of animal milk, direct contact with animal parts, or inhalation of aerosolized particles. In Korea, brucellosis seem to be transmitted through close contact with blood, fetus, urine, and placenta of domestic cow that has been infected by Brucella abortus, or inhalation of B. arbortus while examining or slaughtering cow. Brucella melitensis infection is rare in Korea and there have been no reported cases of B. melitensis originating from other countries until now. This report details a case of complicated brucellosis with infective spondylitis in a 48-year-old male construction worker recently returned from Iraq. Infection with B. melitensis was confirmed using 16s rRNA sequencing and omp31 gene analysis. The patient was successfully treated using a combination of rifampin, doxycycline, and streptomycin, in accordance with WHO guidelines. This is the first reported case of complicated brucellosis with infective spondylitis in Korea caused by B. melitensis originating from Iraq.

Intraoperative Life Threatening Acute Lung Injury Due to Multiple Septic Pulmonary Emboli during Transpedicular Biopsy and Kyphoplasty

A 55-year-old gentleman was presented to our clinic two months after a trivial fall with persistent pain, gibbus at the thoraco-lumbar junction and intact neurology. Radiological and laboratory investigations suggested osteoporotic fracture or metastasis. Due to unremitting pain, a plan was made to do transpedicular biopsy and kyphoplasty. Biopsy needles were inserted into both pedicles and an attempt at aspiration was made. Since the aspirate was dry, 5 to 6 mL of saline was injected through one needle and an attempt at aspiration was made through the other. Three-millilitres of sero-sanguineous material mixed with pus came out and kyphoplasty was deferred. After extubation, the patient developed severe bronchospasm and was transferred to the intensive care unit. Investigations confirmed multiple septic pulmonary emboli and the patient recovered completely after treatment. This report highlights that confirmation of the diagnosis is essential before performing any procedure that increases the intravertebral pressure and the place should have appropriate facilities to manage complications.

Septic Metastatic Lesions Associated with Klebsiella pneumoniae Liver Abscess / 감염과화학요법

Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.

Septic Metastatic Lesions Associated with Klebsiella pneumoniae Liver Abscess / 감염과화학요법

Pyogenic liver abscess is a serious clinical disease with severe complication in about 10-20% of cases. Metastatic septic endophthalmitis and CNS infection are rare but their incidence is increasing in liver abscess patients, especially Klebsiella pneumoniae as etiologic bacteria. Despite appropriate treatment, the outcome is devastating. We experienced a case of septic endophthalmitis, CNS infection (meninigitis, ventriculitis) and infective spondylitis associated with K. pneumoniae liver abscess. The patient had no specific risk factor. After intensive treatement such as systemic intravenous antibiotics with percutaneous abscess drainage and intravitreal injection, liver abscess was resolved completely. But, sequelae were severe. Socket reconstruction after evisceration with debridement on both eye and ventriculo-peritoneal shunt due to hydrocephalus were done. Our experience suggests that attention should be paid to the possibility of septic metastatic lesions as soon as the treatment of K. pneumoniae liver abscess is initiated.

Clinical Evaluation of Tc-99m Ciprofloxacin for the Diagnosis of Infectious Disease / 감염

BACKGROUND: For the evaluation of infectious or inflammatory disease, Tc-99m HMPAO WBC scan has been used. But techniques involving radiolabelled leukocytes scan were difficult, and have failed to distinguish between bacterial infection and non-bacterial inflammation. To overcome this difficulty, we evaluated Tc-99m Ciprofloxacin in clinically suspected bacterial infection. METHODS: We used this agent for 31 patients who had suspected sites of infection. And then we compared the imaging results of these patients with those of radiolabelled leukocyte scan. RESULTS: There was no adverse effect. 29 patients was involved for the interpretation. Infective spondylitis was the most common suspected disease (41%). Bateriologic culture was positive in 10 patients. The most common organism was meticillin-susceptible S. aureus (5 cases). The sensitivity and specificity of Tc- 99m Ciprofloxacin was 83.3% and 66.6%, and those of Tc-99m HMPAO WBC was 62.5% and 83.3%, repectively. For the diagnosis of infective spondylitis the sensitivity of Tc-99m Ciprofloxacin was 80.0% and that of Tc-99m HMPAO WBC was 40.0%. CONCLUSOIN: Tc-99m Ciprofloxacin shows relatively high sensitivity and specificity. Tc-99m Ciprofloxacin was superior to Tc-99m HMPAO WBC for the diagnosis of infection in axial skeleton.